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Infants of Human Immunodeficiency Virus Type 1-Infected Women in Rural South India: Feeding Patterns and Risk of Mother-to-Child Transmission

Read, Jennifer S. MD*; Samuel, N M. PhD; Srijayanth, Parameshwari MB BS; Dharmarajan, Shoba MB BS; Van Hook, Hannah M. BS; Jacob, Mini MD; Junankar, Viju BS; Bethel, James PhD; Yu, Eunice MPH; Stoszek, Sonia K. PhDfor the PMTCT Project

The Pediatric Infectious Disease Journal: January 2010 - Volume 29 - Issue 1 - p 14-17
doi: 10.1097/INF.0b013e3181b20ffc
Original Studies

Background: We assessed the infant feeding choices of HIV-1-infected women in rural Tamil Nadu, India, and risk factors for mother-to-child transmission of HIV-1.

Methods: The study population comprised live born infants of HIV-1-infected women from the antenatal clinics of 2 public hospitals in rural Tamil Nadu, India who were enrolled in a prospective cohort study. All women enrolled in the cohort were offered antiretroviral prophylaxis and infant feeding counseling based on WHO/UNAIDS/UNICEF training materials. Infant study visits were scheduled at birth (within the first 24 hours of life), at 1 week, 1 month, and 2 months after birth, and then every 2 months between 4 and 12 months of age.

Results: One-third of women did not breast-feed their infants. Of those who initiated breast-feeding, the median duration of breast-feeding was approximately 3 months. Among those infants who initiated breast-feeding, the proportion exclusively breast-feeding declined from approximately 70% during the first week of life to 0% by the 8 month visit. The observed rate of mother-to-child transmission of HIV-1 in the entire cohort was 6.5% (95% CI: 1.4%–17.9%). The observed HIV-1 incidence among breast-fed infants was 0% (95% CI: 0%–8.9%).

Conclusion: The overall transmission rate was relatively low, suggesting effectiveness of antiretroviral transmission prophylaxis. The infant feeding choices made may reflect knowledge gained through the educational program and infant feeding counseling provided. Ensuring HIV-1-infected women receive appropriate HIV-1 treatment (for those who meet criteria for treatment) and access to known efficacious interventions to prevent mother-to-child transmission of HIV-1, are essential.

From the *Pediatric, Adolescent, and Maternal AIDS Branch, NICHD, National Institutes of Health, Bethesda, MD; †Department of Experimental Medicine, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India; and ‡Westat, Rockville, MD.

Accepted for publication June 9, 2009.

Supported by the National Institutes of Health (NICHD Contract #N01–3-3345).

Additional PMTCT project staff—Namakkal District Hospital: R. Elango, S. Shobhana (Medical Officers), J. Vijayakumari, G. Jaganathan, H. Rathinam, M. Devi, R. Ramachandran, E. Thangaraj, M. Annadurai, R. Suganya, S. Raju; Rasipuram Government Hospital: K. Senthilkumar, S. Sudha (Medical Officers), M. Ekambaram, A. Jennit, A. Andrew, V. Venila, S. Vijayalakshmi, S. Subramaniam, S. Kavitha, V. Thilagavathy, T. Anitha, S. Kulandaivelu, S. Mahalingam, T. Sivarani, E. Radha, R. Rajkumar; The Tamil Nadu Dr. M.G.R. Medical University: A. Anandhan; Westat: Y. Li, M. Manoharan, D. Collins, A. Shahid.

Address for correspondence: Jennifer S. Read, MD, MS, MPH, DTM&H, Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Executive Building, Room 4B11C, 6100 Executive Boulevard MSC 7510, Bethesda, MD 20892-7510. E-mail: jennifer_read@nih.gov.

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© 2010 Lippincott Williams & Wilkins, Inc.